34371 Differences in half day outpatient dermatology clinic total work relative value units by patient race, sex, and age

Abstract

Dermatology encounters for racial minority, female, and younger patients generate fewer work relative value units (wRVU) per encounter. Longer encounters for older white males may explain differences in wRVU. We aimed to determine whether differences in wRVU by patient sociodemographics persisted after adjusting for encounter length. Adult outpatient dermatology encounters from 9/1/2016-3/31/2020 within an academic center were grouped into 4-hour clinic half days (HD). To examine associations between patient demographics and wRVUs generated per HD, we used mixed linear models adjusted for fixed effects of mean age, proportion of patients who were white, proportion male, and number of encounters and random effect of individual dermatology providers. Overall, 4341 HD were included. Encounters were with predominantly white (70.3%) and female (58.6%) patients. Half days generated a mean 12.9 wRVUs (standard deviation, 4.4) and contained a mean 8.5 (2.5) encounters. HD with all white patients were associated with 3.1 (95% CI 2.7-3.6) more wRVUs than HD with no white patients. HD with all male patients were associated with 0.83 (95% CI 0.4-1.3) more wRVUs than HD with no male patients. A 10-year increase in mean age was associated with a 0.36 (0.25-0.47) increase in wRVU. HD clinics with higher proportions of white, male, and older patients generated more wRVUs. Assuming all HD sessions were of equivalent length, encounter length did not explain why older white males generate more wRVUs per encounter. Further studies should determine if differences in wRVUs stem from undervaluation of conditions that affect racial minority, female, and younger patients.